summer camp registration form

* Indicates required field

Student *

First

Last

Age & Grade as of 9/2016 *

Parent or Guardian *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Email *

Phone Number *

Please note any ALLERGIES?? *

Choose Any *

I/WE understand there is a $100 NON-Refundable Registration Fee due upon submission to reserve a spot. Space is limited!

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